Published on August 29, 2016
Acute and persistent shoulder pain can affect both young and old; however, the causes can be highly varied and require a meticulous diagnostic process to understand the fundamental problem that leads to the solution.
Young and active patients often feel that shoulder pain comes from overuse. This could be the reason, but it is important to understand why. Current exercise routines usually emphasize strengthening the deltoid muscles, but the rotator cuff is largely ignored. This leads to instability syndrome which can cause pain and, worse yet, a mechanical deficiency of the shoulder joint. If the pain is a chronic problem, with no history of a traumatic event, the patient will usually respond to strengthening therapy. Such therapy will require great diligence on the part of the patient and the therapist.
An acute injury, such as a fall or an impact on an outstretched arm, can lead to another type of injury that might require treatment. When an acute injury leads to persistent pain, we frequently order an MRI, which is a diagnostic tool that examines the soft tissue of the shoulder in depth. X-rays only examine the bone structure and results usually show a normal image in people with shoulder pain symptoms. An MRI often indicates the severity of the soft tissue injury and can determine if ongoing conservative treatment (anti-inflammatories, cortisone injections, and therapy) is required, or if surgical intervention is warranted. A torn cartilage or a ruptured tendon will usually not improve on its own, therefore another solution would be needed.
In the current era of medicine, we can solve many of these problems through arthroscopic surgery. This procedure allows the joint to be visualized using a small camera, inserted through tiny punctures in the skin over the joint. This method minimizes scarring, improves the visualization of the problem for the surgeon, and recovery is faster.
Older patients often attribute their shoulder pain to “arthritis”. In fact, arthritis of the shoulder joint is quite unusual. Arthritis is the loss of cartilage in a joint that leads to bone rubbing against bone. Osteoarthritis is most commonly seen in the knee, hip, and even at the base of the thumb, but it is very rare to find it in the shoulder.
The most common cause of shoulder pain in older people is known as Impingement Syndrome. Bursitis is often an element of this syndrome. Bursitis, a frequently used term, is much more precise in describing this problem than the word “arthritis”. With age, blood flow to the rotator cuff decreases and small micro-tears in the tendon lead to tendonitis or bursitis, which can cause an even larger tear.
Impingement Syndrome is a condition that may respond to conservative treatment with cortisone injections to decrease bursitis, or therapy to strengthen the intact rotator cuff. A complete tear in the rotator cuff implies that the torn tendon has separated from the bone. In this case, it will be physically impossible for the patient to lift the arm or they will experience severe pain when trying to do so. Impingement syndrome is characterized by feeling pain when the arm is raised, pain that worsens at night and makes it impossible to lie on the affected shoulder.
Once the pain becomes chronic and does not respond to therapy or other conservative treatments, surgery is indicated. This surgery can be performed arthroscopically through small incisions or portals. The decision for arthroscopic surgery will depend on the severity of the injury and the surgeon’s preference. Most patients who need surgical intervention require about a month of immobilization in a sling and several months of post-operative therapy directed by the surgeon. The shoulder is a demanding joint and requires patience from both the affected person and the surgeon in charge. Recovery is normally not quick, but diligently adhering to the therapy protocol will, in most cases, lead to achieving good results and a functional shoulder with minimal or no pain.
The key to treating a painful shoulder is finding the right specialist and undergoing a physical examination of the affected area ordered by the surgeon. Therapy frequently plays a paramount role in the recovery of this particular joint. Arthroscopic techniques allow for a faster recovery with minimal pain if surgery is indicated.
Dr. Alejandro Badia, Founder of the Badia Hand to Shoulder Center, a fully integrated facility that features the latest technology for the treatment of the upper extremity including the hand, wrist, elbow, and shoulder, conveniently located near the Miami International Airport in the United States, treats many shoulder problems such as rotator cuff tears, labral tears, impingement syndrome, and adhesive capsulitis. All these conditions are managed via arthroscopic surgery, a minimally invasive procedure that helps the patient recover much faster than traditional surgery. However, it is important to note that for primary shoulder arthritis, patients must undergo some type of shoulder replacement, depending on the severity and characteristics of the arthritis. Most are candidates for partial resurfacing replacements; however, in more advanced cases, a total shoulder replacement may be necessary. For patients with rotator cuff arthropathy, a reverse shoulder replacement is performed.
For more information, visit: www.drbadia.com.
